Motorcycle Extremity Injuries in South-East Nigeria: A Multicenter Study

Background: Motorcycle extremity injuries are an important public health concern in developing countries though under‑reported. This study aimed to determine the pattern of motorcycle extremity injuries and identify the potential areas to facilitate preventive strategies and improved outcomes. Patients and Methods: This was a prospective study of all the patients with motorcycle injuries that visited emergency rooms of three Nigerian tertiary hospitals from February 1, 2015, to July 31, 2016. Results: Of the 587 patients with motorcycle injuries, 393 (67%) of them sustained extremity injuries. The male: female ratio was 2.3:1; the age range was 1.25–80 years with a mean of 30 ± 14 years. Motorcycle collisions with motor vehicles were the topmost mechanism of injury. The lower extremity was the most common site involved. Fractures, abrasions and lacerations were the three top injuries sustained. One hundred and seventeen (29.8%) of them were multiply injured patients. Traumatic brain injury (TBI) (23.7%) was the most common associated injury. None of the victims wore a crash helmet or  extremity protective gear at the time of injury. The mean injury‑hospital arrival interval was 84 h and delayed presentation to the hospital correlated with the presence of extremity fractures. The mortality rate was 2%, and TBI was involved in 87.5% of the mortalities. Conclusion: In this study, extremity injury is an important component of injury associated with motorcycle road traffic accidents. This calls for preventive strategies based on the observed pattern, and the use of extremity protective gear by motorcyclist. Keywords: Extremities, injuries, motorcycle, multicenter, Nigeria&nbsp

Orthopedic Day-case Surgery in Nigeria: A Single-center Experience

Background: The concept of day-case surgeries is relevant in orthopedic specialty in developing countries, where orthopedic elective procedures have relatively longer duration of surgical waiting time, mainly due to lack of inpatient bed space. We aimed to determine the scope, safety and outcome of orthopedic day-case surgeries in a Nigerian setting, and identify potential areas for intervention to improve the practice. Methods: This was a 12-month prospective study of 71 eligible, consenting and consecutive patients who presented at the National Orthopedic Hospital Enugu and were carefully selected and prepared for orthopedic day-case surgeries. Results: Within the period of study, 53 of 540 elective orthopedic procedures were carried out as daycase, giving a day-case surgery rate of 9.8%. Of the patients enrolled, male to female ratio was 1.2:1 and age range was 8 months to 76 years. Eighteen (25.4%) patients had their day-case  procedure cancelled on the day of surgery. The commonest procedure was removal of implant. Conversion rate was 32% mainly due to operation occurring late. Complication (mainly pain) rate was 30%, and correlated with duration of procedure (p<0.006). The satisfaction rate among patients was 98%; no re-admission or mortality was observed. Conclusion: In this study, orthopedic day-case procedures were safe, though there was low use of daycase surgery in scope, complexity and  number of procedures. This and the high conversion rate observed call for a dedicated day-case unit and measures to facilitate timelines of the procedures. Keywords: Orthopedics, Day-case surger

Pattern of presentation and indications for amputation in national Orthopaedic Hospital, Enugu

Background: Globally, an increase in the rate of amputation is noted and it could be attributed to the sudden surge in the incidence of non-communicable diseases especially diabetes and peripheral vascular disease which is a complication of hypertension. There has been some variation in the pattern of presentation in different climes and locality depending on the availability of expertise and the infrastructures available for limb salvage procedures.Objective: To determine the indications, demographic pattern and clinical presentation of patients that had amputation in National Orthopaedic Hospital Enugu (NOHE).Methodology: All patients who had amputation in NOHE from 1 of September 2015 to 31 of August 2017 were recruited prospectively. The indications for amputation, demographic data and pattern of presentation of the patients were analysed with SPSS version 20.Results: A total of 137 patients were recruited concurrently. Male to female ratio was 1.6:1. Dual peak age range of 61-70 years (22.6%) and 21-30years (20.4%) were observed. There was relative preponderance of traders (27.7%) with secondary school education (39.4%) and left lower limb was mostly involved 52.6%. Commonest mode of presentation is darkish discolouration of the foot (45.9%), with duration of symptoms most commonly between 1 - 6 months (40.9%) and 39.4% had no prior treatment before presentation. Diabetes foot gangrene (in 39%) followed by trauma (24.1%) were the leading cause of amputation from our study and above knee amputation was more commonly done (44%).Conclusion: There is dual peaks in age groups with male preponderance in the amputations done. It commonly involved left lower limb in traders with secondary education and the commonest indication being Diabetic Foot Gangrene. Public enlightenment on diabetes is important to reduce the incidence of amputation.Keywords: Amputation, indication, Pattern, Diabete

Assessment of Treatment Outcomes in the Management of Club foot using the Ponseti Technique:A cross-sectional study

BACKGROUND: The Ponseti technique remains the preferred method for club foot treatment. Although measures of treatment outcomes have been well documented, there is no consensus on the determinants of those outcomes. This study aims to assess treatment outcomes and the factors which can influence treatment outcomes.MATERIALS AND METHODS: This is a cross-sectional study. A total of 472 children representing 748 feet in total were recruited. Patient characteristics such as age at presentation, gender, tenotomy, walking with or without deformity, parental educational status and occupation were documented. Outcomes of care were assessed using indictors such as parents' satisfaction with the outcome of treatment and the patients' ambulation without deformity. The relationships between the determinant factors and these outcomes were explored using multivariable binary logistic regression.RESULTS: Most of the children (69.1%) were aged below 2 years. Brace compliance was very high (89.9%). The pre-treatment average Pirani scores were 3.9 ± 1.8 and 4.3 ± 1.8 for the right and left feet, respectively. Majority (88.3%) of the children achieved ambulation without deformity, whereas most (87%) of the parents were satisfied with the treatment outcomes. In total, parental satisfaction with child's treatment outcomes was lower in parents who were not formally educated odds ratio (OR) = 0.19 (95% confidence interval [CI] 0.08-0.43), but parental satisfaction was lower if the child had higher Pirani score OR = 0.77 (95% CI 0.62-0.96). Children who had more casts applied to the affected foot were more likely to walk without deformity OR = 1.24 (95% CI 1.01-1.52).CONCLUSIONS: This study revealed that treatment outcomes in children with club foot can be determined by some sociodemographic and treatment-related factors.</p

Telemedicine in the age of the pandemics: The prospects of web-based remote patient monitoring systems for orthopaedic ambulatory care management in the developing economies

Objective The goal of this research was to demonstrate the efficacy of telemedicine via design, implementation and evaluation of a web-based remote patient monitoring system (WB-RPMS) across the tertiary/university teaching hospitals in a developing country Nigeria, as a tool to continue to expand access to an affordable and resilient tertiary healthcare system through the challenging times of the COVID-19 pandemic or any future disruptions. Methods This research employed an agile and human-centred design thinking philosophy, which saw the researchers iteratively collaborate with clinicians across the system development value chain. It also employed qualitative and quantitative research methods for new system evaluations. After the system's development, a 20-patient sample was randomly selected from members of the National Youth Service Corp to evaluate the WB-RPMS Patient Portal for usability and user experience through a survey based on the system usability scale. Again, the COREQ standards for reporting research result were adopted for this study. Results The evaluation of the WB-RPMS Patient Portal by a select patient sample showed that 95.0% of the respondents believed that they would like to use the system frequently. It was also discovered that 90.0% of all respondents also indicated that they found the Patient Portal to be simple; 85.0% of the respondents believed and indicated that the WB-RPMS Patient Portal was easy to use. Conclusions The result of the usability evaluation of the developed WB-RPMS Patient Portal showed that it was well received by the select patient sample and by the clinicians who participated in the development process. In fact, the performance of the system shows that it has the potential to remotely support and sustain improved access to affordable healthcare for outpatients in developing countries even during times of uncertainties and disruptions as recently occasioned by COVID-19 pandemic

Experience with accelerated ponseti technique for treatment of idiopathic clubfoot in a regional orthopaedic hospital in Nigeria

Introduction: Idiopathic talipes equinovarus (ITEV) 'aka clubfoot' is the most common foot deformity in children. Ponseti technique had been accepted as a standard method for correction. The traditional Ponseti technique for correction is well known. Accelerated Ponseti technique is said to offer some advantages over the standard technique. The aim of this study was to determine and document the efficiency and success rate of accelerated Ponseti technique. Methods: This was a prospective interventional study which lasted 26 months from February 2017 to April 2019. Twenty-eight patients with 42 feets who met the inclusion criteria were recruited. They had serial manipulation and casting twice every week till percutaneous tenotomy was done as indicated. Final cast usually applied after tenotomy and left for 3weeks. Each patient was followed up for a year corresponding to 9 months after the commencement of night bracing. Data were analysed using SPSS version 20. Results: The mean age was 8.1 months with a range of 1–36 months. The mean Pirani score recorded was 4.4, while the mean number of casting sessions was 3.6 and the mean duration of treatment was 12.4 days. The tenotomy rate recorded was 42.9%. Pre-bracing assessment of Pirani score, passive ankle dorsiflexion and foot abduction done and repeated after a year revealed optimal correction. The relapsed rate at 1 year was 4.8%. The only complication observed was pressure sore in a patient. Conclusion: The accelerated Ponseti technique is an efficient method of treatment of ITEV in a much shorter time with a higher success rate. It facilitates compliance with treatment